Understanding Herniated Disks

A herniated disk, also called a slipped or ruptured disk, affects the cushioning tissue between the vertebrae (bones) of the spine. Disks are your spine’s shock absorbers; they help your spine stay flexible. When you move your back, the disks absorb the pressure on your spine.

When a herniated disk occurs, the jelly-like center of the disk bulges or leaks through the outer ring of the disk. This puts added pressure on the nerves and spinal cord.

Herniated disks occur most frequently in the lower back but can also happen in the neck. A slipped disk in the neck can pinch the spinal cord and cause major issues.

People often describe herniated disk pain as an electric or burning pain that shoots from the back down into the leg, said Andrew Koivuniemi, MD, PhD, a Lafayette, Indiana, neurosurgeon with Franciscan Physician Network Neurosurgery & Pain Specialists.

“When a disk herniates in the back, it can go in all different directions,” Dr. Koivuniemi said. “It's really a problem for you though, when that disk starts pinching one of the nerves that's inside your back or, even worse, when it starts pinching the spinal cord. We have disks all the way up and down our spine from our neck down to our low back. And if a disk herniates up in the neck, it can pinch the spinal cord and that can cause major issues. Normally, most of the time what we see is those disks herniating in the low back. Down there, there's actually no spinal cord. It's just nerve roots. Still if one of those nerve roots gets pinched or irritated by that herniated disk, it can cause a lot of issues, specifically pain and weakness.”

The Causes of Herniated Disk In Your Back

Several factors can increase your risk of a herniated disk, said Dr. Koivuniemi. One common factor is age.

“As you age, the disks in your spine become less flexible and can make you more prone to damage or injury,” he said.

A herniated disk can occur while playing sports, picking up heavy objects or working manual labor jobs. Sudden pressure, smoking, repetitive strenuous activities, improper lifting (such as twisting and turning while picking up something heavy) and carrying extra body weight that puts stress on the disks in the lower back can all help weaken disks in the lower back.

Other risk factors for a herniated disk include:

• Carrying extra body weight
• Genetics
• Improper lifting
• Injuries such as falls, accidents or sports-related trauma
• Lifestyle habits such as poor posture
• Repetitive motion

“Sometimes, we’ll see patients who just woke up with a herniated disk,” said Dr. Koivuniemi.

Various causes can affect people with all types of backgrounds.

Symptoms Of A Herniated Disk

The main symptoms of a herniated disk include leg pain, numbness, weakness or tingling. But pain can also extend to other parts of the body.

“The pain that you experience with a herniated disk is classically described as sort of an electric or burning pain that shoots from the back and down into your leg. The reason that pain shoots into your leg is because the nerve carries information from that part of the body,” said Dr. Koivuniemi. “When that nerve gets irritated, the brain experiences pain in that part of the body because the brain can't map to the nerve.”

The brain only knows where the pain sensation should come from.

“That’s one thing that surprises patients. They often ask me, ‘Well, doc, why are we looking at my back? It’s my leg that’s killing me,’” Dr. Koivuniemi said.

Several nerves travel down the back of your leg.

“For example, one nerve, the L5, helps you raise your foot,” said Dr. Koivuniemi. “A classic symptom is a foot drop — where the foot has a hard time lifting its toe as you’re walking, and it can catch and drag.”

As other nerves get pinched, they can cause weakness in your knees or hips.

“You may feel especially severe pain, like sharp shooting pain, after any sort of strain, including coughing or prolonged periods of sitting or standing,” said Dr. Koivuniemi.

This pain, called sciatica pain, runs from your lower back through your buttocks and down one of your legs.

You should go to the emergency room if pain, numbness and weakness:

• spreads to one or both of your legs
• causes a loss of bladder or bowel control or are unable to urinate
• produces a loss of sensation in your inner thighs, back of the legs and areas around the rectum

These could be a sign of compression in the spinal nerve roots, which can require emergency surgery to relieve the pressure.

Diagnosing Herniated Disks

When evaluating a person for a herniated disk, doctors will take a medical history and do a physical exam. Many times, people will complain of weakness.

“We can perform a straight leg test where the patient lies flat and a doctor lifts their leg. This provocative maneuver usually stretches the nerve and makes the irritation worse,” said Dr. Koivuniemi.

Since increased pain from such a movement is not enough to make the diagnosis, doctors use other diagnostic tools, too.

“We usually need imaging, the gold standard, such as magnetic resonance imaging (MRI), where we can see the nerves and disks. Imaging lets us identify the exact location and how the disk pinches the nerves,” Dr. Koivuniemi said.

However, since herniated disks account for only a small percent of low back pain, doctors generally don’t do an MRI unless a person has both back pain and warning signs of a serious injury or disease.

If a person can’t get an MRI, doctors can use a CT myelogram, an imaging procedure that examines the vertebrae and disks.

Pain And Herniated Disks

Plenty of people with herniated disks never know it. In fact, studies have found that roughly 22 to 40% of people without back pain actually have herniated disks. Many people with back pain also have herniated disks, but the two problems aren’t necessarily related.

Many cases of back pain occur from sprained or strained muscles in the lower back, not leaking disks. According to a New England Journal of Medicine report, herniated disks account for only about 4% of lower back pain cases.

Herniated Disk Treatments

If you rest and take good care of your back, there’s a good chance your disk will get better without medical treatment. Most herniated disks take four to six weeks to improve, and many people can return to normal activities within a couple of months.

Taking the strain off your back is the first step in the healing process. Other helpful tips during recovery include:

• Don’t lift heavy objects.
• Refrain from bending repeatedly.
• Don’t sit for long periods.
• Participate in regular exercise to strengthen your back and promote healing.
• Take over-the-counter pain relievers such as aspirin or ibuprofen.
• Use a cold compress on the aching spot for 15 minutes at a time, four times a day.
• See your doctor about corticosteroid injections ­– medications to calm inflammation.
• Try alternative, or non-medical therapies, such as acupuncture.
• Surgery can also help in cases of nerve damage that grows steadily worse or pain that interferes with the bowel and bladder function.

Some people with back pain have also tried transcutaneous electrical nerve stimulation (TENS), where a physical therapist uses a battery to send very modest electrical currents into the muscle. This electrical current can help stimulate the body to release endorphins, the body’s natural painkillers.

Talk to your healthcare provider if you’re experiencing back pain, numbness or weakness. They can determine if you may have a herniated disk. Don’t let the pain and discomfort hold you back from living your life to the fullest. Schedule an appointment with your Franciscan Health doctor today and get on the path to a healthier, more comfortable you.

Listen Now: Herniated Disks

Franciscan Health neurosurgeon Dr. Andrew Koivuniemi leads a discussion focusing on herniated discs, how they are caused, how they can be prevented, and some of the common treatment options on the Franciscan Health DocPod pdocast.